SECTION 125 CAFETERIA PLAN ELECTION FORM: - csun Preview on Page 1

SECTION 125 CAFETERIA PLAN ELECTION FORM: - csun 2026

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  1. Click ‘Get Form’ to open the SECTION 125 CAFETERIA PLAN ELECTION FORM in the editor.
  2. Begin by entering your personal information, including your name, Social Security Number (SSN), address, phone number, and birth date. Ensure all details are accurate for processing.
  3. Select your pay cycle from the options provided: Weekly, Bi-Weekly, Semi-Monthly, or Monthly. This will determine how your contributions are calculated.
  4. Indicate your pre-tax election choices for group medical insurance categories by filling in the premium amounts for health/medical, dental, and vision insurance as applicable.
  5. Complete the flexible spending account sections by entering amounts for dependent care expenses and medical out-of-pocket expenses. Be mindful of the maximum limits specified.
  6. Review the Flex-Advantage Plan Election Agreement carefully. Once satisfied, sign and date the form to finalize your elections.

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Starting a section 125 plan requires following these three simple steps: Complete the necessary plan documents. Notify employees that you are offering a Section 125 cafeteria plan. Hire a TPA to administer your Section 125 plan and process reimbursements.
Section 125 plans must be created by an employer. When a plan is created, the benefits are available to employees, their spouses, and their dependents. Depending on the circumstances and details of the plan, Section 125 benefits may also extend to former employees, but the plan cannot exist primarily for them.
Get your written plan today Work at no cost or risk with a certified plan consultant via email or call 1-888-755-3373. Or, go ahead and order your Core 125 plan document package (below) and well call you if we have questions on the information you provide us.

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Starting a section 125 plan requires following these three simple steps: Complete the necessary plan documents. Notify employees that you are offering a Section 125 cafeteria plan. Hire a TPA to administer your Section 125 plan and process reimbursements.
The IRS requires a Section 125 Plan Document so that employees can pay for health premiums, FSA contributions, and other group benefits with tax-free payroll deductions. Employers save an average 8% to 10% in payroll taxes, too.
A cafeteria plan, also known as a section 125 plan, is a written plan that offers employees a choice between receiving their compensation in cash or as part of an employee benefit.
The written plan must specifically describe all benefits and establish rules for eligibility and elections. A section 125 plan is the only means by which an employer can offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable.
The written plan must specifically describe all benefits and establish rules for eligibility and elections. A section 125 plan is the only means by which an employer can offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable.

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